on July 3, 2008
Published online before print July 3, 2008, doi: 10.1161/ATVBAHA.108.170431
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Submitted on May 15, 2008
Accepted on June 22, 2008
Lipoprotein Particle Concentrations May Explain the Absence of Coronary Protection in the Women's Health Initiative Hormone Trials
Judith Hsia *;
From the Department of Medicine (J.H.), George Washington University, Washington, DC; Liposcience Inc (J.D.O.), Raleigh, NC; National Heart, Lung, and Blood Institute (J.R.), National Institutes of Health, Bethesda, Md; Fred Hutchinson Cancer Research Center (L.W., B.L.), Seattle, Wash; the Department of Epidemiology & Social Medicine (S.S.), Albert Einstein College of Medicine, Bronx, NY; the Department of Obstetrics and Gynecology (S.L.H.), Detroit Medical Center, Detroit, Mich; the Department of Medicine (J.G.R.), University of Iowa, Iowa City; and the Department of Epidemiology (L.H.K.), University of Pittsburgh, Pa.
* To whom correspondence should be addressed. E-mail: judith.hsia{at}astrazeneca.com.
Objective—The Women's Health Initiative randomized hormone trials unexpectedly demonstrated an increase in early coronary events. In an effort to explain this finding, we examined lipoprotein particle concentrations and their interactions with hormone therapy in a case–control substudy.
Methods and Results—We randomized 16 608 postmenopausal women with intact uterus to conjugated estrogens 0.625 mg with medroxyprogesterone acetate 2.5 mg daily or to placebo, and 10 739 women with prior hysterectomy to conjugated estrogens 0.625 mg daily or placebo, and measured lipoprotein subclasses by nuclear magnetic resonance spectroscopy at baseline and year 1 in 354 women with early coronary events and matched controls. Postmenopausal hormone therapy raised high-density lipoprotein cholesterol and particle concentration and reduced low-density lipoprotein cholesterol (LDL-C; all P<0.001 versus placebo). In contrast, neither unopposed estrogen nor estrogen with progestin lowered low-density lipoprotein particle concentration (LDL-P).
Conclusions—Postmenopausal hormone therapy–induced reductions in LDL-C were not paralleled by favorable effects on LDL-P. This finding may account for the absence of coronary protection conferred by estrogen in the randomized hormone trials.
Key words: lipoproteins • estrogen • women • coronary heart disease
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